Association of dipeptidyl peptidase-4 inhibitor use and the risk of asthma development among type 2 diabetes patients.

BACKGROUND: Numerous studies have shown that dipeptidyl peptidase-4 inhibitors (DPP-4i) may regulate immunological pathways implicated in asthma. The association between DPP-4i use and risk of asthma development is limited, however. AIM: We aimed to evaluate if DPP-4i treatment in individuals with type 2 diabetes mellitus (T2DM) is associated with a lower risk and severity of asthma. METHODS: We performed a population-based retrospective cohort study using the Longitudinal National Health Insurance Research database between 2008 and 2015. After one-to-four propensity score matching from 1,914,201 patients with defined criteria, we enrolled 3001 patients who were on DPP-4i (DPP-4i group) for a diagnosis of T2DM but without a diagnosis of asthma for further analysis. Cox proportional hazards regression analysis was performed to estimate and compare the risk of developing and severity of asthma, including no acute exacerbations event (No-AE), acute exacerbations (AEs), status asthmaticus (Status), and required endotracheal intubation (ET-tube intubated), between the two groups. RESULTS: The participants had a mean age of 66.05 ± 17.23 years and the mean follow-up time was 4.96 ± 4.39 years. The risk of asthma development was significantly lower in the DPP-4i group than in the non-DPP-4i group [adjusted hazard ratio (HR) = 0.65; 95% confidence interval (CI) = 0.29-0.83; p < 0.001], with a class effect. This trend was observed for severity of asthma as No-AE (HR = 0.55; 95% CI = 0.24-0.70; p < 0.001), AE (HR = 0.57; 95% CI = 0.26-0.73; p < 0.001), and Status (HR = 0.78; 95% CI = 0.35-0.99; p = 0.047), but not in ET-tube intubated cases (HR = 0.96; 95% CI = 0.43-1.22; p = 0.258). CONCLUSION: The use of DPP-4i decreased the risk and severity of asthma with a class effect among No-AE, AE, status of asthma events, but not in ET-tube intubated events. Our report suggests that DPP-4i may play a role in attenuating the impact of asthma on incidence in the future and on more severe forms of disease exacerbation in T2DM patients.

Association between Grip Strength, Obesity, and Cardiometabolic Risk Factors among the Community-Dwelling Elderly Population in Taiwan.

The aim of this study was to evaluate the association between grip strength, obesity, and cardiometabolic risk factors among elderly individuals with different grip strength statuses and weight statuses in Taiwan. We conducted a series of community-based health surveys among the elderly population in Chiayi County, Taiwan from 2017 to 2019. This is a cross-sectionally designed health check-up program that was conducted by the local public health bureau. Anthropometric characteristics, handgrip strength, diabetes, and cardiometabolic risk profiles were measured using standard methods. This study recruited 3739 subjects (1600 males and 2139 females). The non-obese subjects had lower blood glucose (BG) levels compared to the obese subjects. The BG levels of non-obese and obese subjects were 102.7 ± 25.6 mg/dL vs. 109.1 ± 34.3 mg/dL for males; and 102.8 ± 30.1 mg/dL vs. 112.5 ± 40.3 mg/dL for females (both p < 0.001). The grip strength was negatively associated with BG in both sexes (ß = -0.357, p < 0.001 for males and ß = -0.385, p < 0.05 for females). The relationship between the grip strength and the risk of diabetes showed that for every 1 kg increase in the grip strength, there was a 4.1% and 4.5% decrease in the risk for developing diabetes for males and females, respectively (OR = 0.959, 95% CI = 0.940-0.979 for males and OR = 0.955, 95% CI = 0.932-0.978 for females). A higher handgrip strength is associated with a lower BG level and a lower risk for diabetes mellitus in the elderly Taiwanese subjects. Additional health promotion should focus on the obese and sarcopenic population to prevent cardiometabolic comorbidities in later life.

Dipeptidyl peptidase-4 inhibitors attenuates osteoporosis in patients with diabetes: A nationwide, retrospective, matched-cohort study in Taiwan.

BACKGROUND: Patients with diabetes have a relatively high risk of fracture due to osteoporosis. However, the risk of osteoporosis associated with the use of oral hypoglycemic drugs and dipeptidyl peptidase-4 inhibitor (DPP-4i) by patients with diabetes is unclear. This study aimed to explore the effect of DPP-4i on the risk of osteoporosis in Taiwanese patients with type 2 diabetes mellitus (T2DM). METHODS: This study enrolled 6339 patients on DPP-4i (DPP-4i group) and 25 356 patients without DPP-4i (non-DPP-4i group). They were matched by 1:4 propensity score matching, using confounding variables including sex, age, comorbidities, medication, and index year. Cox proportional hazards analysis was used to compare hospitalization and mortality during an average follow-up period of 7 years. RESULTS: The mean age of patients in the two groups was 66 years. Men were slightly higher in number (51.79%) than women. At the end of the follow-up period, 113 (0.36%) patients had osteoporosis, of which 15 (0.24%) were in the case group and 98 (0.39%) in the control group. The risk of all-cause osteoporosis was significantly lower in the DPP-4i group than in the non-DPP-4i group (adjusted hazard ratio [HR] 0.616; 95% confidence interval [CI] 0.358-0.961; p = 0.011). Kaplan-Meier analysis showed that the preventive effect on osteoporosis was positively correlated with the cumulative dose of DPP-4i (log-rank, p = 0.039) with the class effect. CONCLUSION: Compared with not using DPP-4i, the use of DPP-4i in Taiwanese T2DM patients was associated with a lower risk of osteoporosis due to the class effect, and the preventive effect was dose-dependent. However, larger prospective studies are needed to validate this finding and to explore the possible mechanism of the preventive effect of DPP-4i.

Circulating protein disulfide isomerase family member 4 is associated with type 2 diabetes mellitus, insulin sensitivity, and obesity.

AIMS: Endoplasmic reticulum (ER) stress is associated with obesity and type 2 diabetes mellitus (T2DM) and increasing evidence demonstrates that some ER stress markers can represent the severity of metabolic dysfunction in either cellular or animal models. However, no appropriate molecule has been identified to demonstrate these relationships in clinical practice. METHODS: To determine whether the serum level of the ER chaperone, protein disulfide isomerase family A, member 4 (PDIA4), is associated with type 2 diabetes mellitus, obesity, and insulin sensitivity, we conducted a cross-sectional study for which a total of 553 adults, including 159 with normal glucose tolerance (NGT), 169 with prediabetes (Pre-DM), and 225 with newly diagnosed T2DM, were recruited. RESULTS: Serum PDIA4 levels were significantly higher in patients with T2DM than in those with NGT (P < 0.001), even after adjustment for potential confounders. These levels correlated positively with fasting plasma glucose, BMI, waist circumference as well as high-sensitivity C-reactive protein levels, and negatively and strongly correlated with insulin sensitivity. In a multivariate logistic regression analysis, higher serum PDIA4 concentration was observed to be significantly associated with an increased risk of T2DM. CONCLUSIONS: Our findings provide new mechanistic insights linking ER stress, T2DM, insulin sensitivity, and obesity, which may, in part, account for the ER chaperone properties associated with PDIA4. The results suggest that PDIA4 may serve as a potential instigator of and a putative therapeutic target for T2DM.

Association between glucokinase regulator gene polymorphisms and serum uric acid levels in Taiwanese adolescents.

The glucokinase regulator gene (GCKR) is located on chromosome 2p23. It plays a crucial role in maintaining plasma glucose homeostasis and metabolic traits. Recently, genome-wide association studies have revealed a positive association between hyperuricemia and GCKR variants in adults. This study investigated this genetic association in Taiwanese adolescents. Data were collected from our previous cross-sectional study (Taipei Children Heart Study). The frequencies of various genotypes (CC, CT, and TT) or alleles (C and T) of the GCKR intronic single-nucleotide polymorphism (SNP) rs780094 and the coding SNP rs1260326 (Pro446Leu, a common 1403C-T transition) were compared between a total of 968 Taiwanese adolescents (473 boys, 495 girls) with hyperuricemia or normal uric acid levels on the basis of gender differences. Logistic and linear regression analyses explored the role of GCKR in abnormal uric acid (UA) levels. Boys had higher UA levels than girls (6.68 ± 1.29 and 5.23 ± 0.95 mg/dl, respectively, p < 0.001). The analysis of both SNPs in girls revealed that the T allele was more likely to appear in patients with hyperuricemia than the C allele. After adjusting for confounders, the odds ratio (OR) for hyperuricemia incidence in the TT genotype was 1.75 (95% confidence interval [CI] 1.02-3.00), which was higher than that in the C allele carriers in rs1260326 in the girl population. Similarly, the TT genotypes had a higher risk of hyperuricemia, with an OR of 2.29 (95% CI 1.11-4.73) for rs1260326 and 2.28 (95% CI 1.09-4.75) for rs780094, than the CC genotype in girl adolescents. The T (Leu446) allele of GCKR rs1260326 polymorphism is associated with higher UA levels in Taiwanese adolescent girls.

Traditional Chinese medicine attenuates hospitalization and mortality risks in diabetic patients with carcinoma in situ in Taiwan.

BACKGROUND: Diabetic patients are at high risk of developing cancer. Traditional Chinese medicine (TCM) has become increasingly popular as an adjuvant treatment for patients with chronic diseases, and some studies have identified its beneficial effect in diabetic patients with cancer. The purpoes of this study was to outline the potential of TCM to attenuate hospitalization and mortality rates in diabetic patients with carcinoma in situ (CIS). METHODS: A total of 6,987 diabetic subjects with CIS under TCM therapy were selected from the National Health Insurance Research Database of Taiwan, along with 38,800 of 1:1 sex-, age-, and index year-matched controls without TCM therapy. Cox proportional hazard analysis was conducted to compare hospitalization and mortality rates during an average of 15 years of follow-up. RESULTS: A total of 3,999/1,393 enrolled-subjects (28.62%/9.97%) had hospitalization/mortality, including 1,777/661 in the TCM group (25.43%/9.46%) and 2,222/732 in the control group (31.80%/10.48%). Cox proportional hazard regression analysis showed a lower rate of hospitalization and mortality for subjects in the TCM group (adjusted HR=0.536; 95% CI=0.367-0.780, P<0.001; adjusted HR=0.783; 95% CI=0.574-0.974, P = 0.022). Kaplan-Meier analysis showed that the cumulative risk of hospitalization and mortality in the case and control groups was significantly different (log rank, P<0.001 and P = 0.011, respectively). CONCLUSIONS: Diabetic patients with CIS under TCM therapy were associated with lower hospitalization and mortality rates compared to those without TCM therapy. Thus, TCM application may reduce the burden of national medical resources.

Obesity, waist circumference, and appendicular muscle mass ratio in relation to blood pressure among the community-dwelling elderly population in Taiwan.

Hypertension is known to be related to obesity and both are the major factors for cardiovascular diseases. The relationship between body composition and blood pressure (BP) are discussed recently. Our study aims to evaluate the association between waist circumference (WC) and appendicular muscle mass (AMM) in relation to BP among the community-dwelling elderly population. Total 3739 patients (1600 males and 2139 females) were recruited in a series of community-based surveys that were conducted among the elderly population in Taiwan from 2017 to 2019. We collected data on anthropometric characteristics, handgrip strength, and BP using standard methods. AMM was calculated with an equation. History of chronic disease and lifestyle profiles were collected using questionnaires. The group with high AMM to body weight ratio (AMMW) showed lower systolic BP (SBP) (136.8 ± 19.1 to 140.6 ± 17.0 for males; 137.8 ± 18.3 to 142.7 ± 17.5 for females, both P < .001). Among central obese persons those with higher AMMW ratio had lower SBP. In the final model, AMMW in percentage is negatively associated to SBP (ß = -0.641 in male, -0.780 in female, both P < .01). In other words, every 10% increase in AMMW is associated with decrease of SBP 6.41 mmHg in male and 7.80 mmHg in female. Obesity and central obesity were positively associated with BP. The AMMW ratio was negatively associated with HTN and with a protective effect on BP even among the central obese. Health promotion programs to increase physical training may prevent hypertension among the elderly in Taiwan.

Effect of time-restricted feeding on body composition and cardio-metabolic risk in middle-aged women in Taiwan.

OBJECTIVES: We sought to investigate the effects of time-restricted feeding (TRF) and a traditional weight-loss method on body composition and cardio-metabolic risk factors in middle-aged women. METHODS: In a single-center, randomized, open-label, parallel-group design, women ages 40 to 65 y with body mass index ≥ 24 kg/m2 or waist circumference > 80 cm were recruited. They were guided to a daily low-calorie diet of 1400 kcal and randomly assigned into a TRF group (limit 8 h of eating time and fasting for 16 h) or a non-TRF group (traditional weight-loss method, unrestricted eating time) for 8 wk. Body composition, blood pressure, blood biochemical variables, and insulin resistance status were measured before and after intervention. RESULTS: Body weight, body mass index, waist circumference, and body fat mass decreased significantly in both groups after 8 wk of intervention (P < 0.05). Body weight decreased more in the TRF group than the non-TRF group (-4.1% ± 2.8% versus -2.4% ± 2.5%; P = 0.012), as did diastolic blood pressure (75.3 ± 11.2 mm Hg versus 70.5 ± 9.4 mm Hg; P = 0.012). There were no statistical differences between the two groups in total cholesterol, triacylglycerols, high- or low-density lipoprotein cholesterol, and fasting insulin level. However, fasting glucose and insulin resistance status increased significantly for the TRF group after the intervention (respectively, 88.3 ± 7.6 mg/dL versus 92.6 ± 9.6 mg/dL, P = 0.003; 1.7 ± 0.7 versus 2.1 ± 1.0, P = 0.048). CONCLUSION: The weight loss and reduction in diastolic blood pressure using the TRF method were better than with the traditional weight-loss method. However, this method may increase fasting glucose levels and adverse insulin resistance status.

Using Healthcare Complaints Analysis Tool to Evaluate Patient Complaints during the COVID-19 Pandemic at a Medical Center in Taiwan.

The purpose of this study is to evaluate patient complaints using the Healthcare Complaints Analysis Tool (HCAT) during the COVID-19 pandemic in 2021 in Taiwan. Additionally, the study examines the distribution and type of patient complaints before and during the COVID-19 pandemic to provide a better clinical procedure, hospital management and patient relationship. This study utilizes a cross-sectional design. We collected patient complaints from January 2021 to December 2021 at a medical center in Southern Taiwan. Using the Healthcare Complaints Analysis Tool (HCAT), the patient complaints are classified and coded into three major domains (clinical, management and relationship), and seven problem categories (quality, safety, environment, institutional process, respect and patient rights, listening and communication). We further compared and categorized the complaints based on whether they were COVID-19-related or not and whether it was before or during the COVID-19 pandemic to understand the differences in patient complaints. In total, we collected 584 events of patient complaints. Based on the HCAT domains, the complaints about management were the highest, at 52.9%, followed by complaints about relationship, about 37.7%. According to the types of problem, the complaints about the environment were the highest, about 32.5% (190/584), followed by communication at about 29.6% (173/584), and institutional process at about 20.4% (119/584). There were 178 COVID-19-related complaints and they were made more frequently during Q3 and Q4 (from mid-June to December) which was the pandemic period in 2021 in Taiwan. Among the COVID-19-related complaints, the most frequent were in the environment domain with 114 cases (about 65.7% of COVID-19-related complaints). The domains of patient complaints were statistically different between COVID-19-related and non-related (p < 0.001). During the COVID-19 pandemic, the proportion of COVID-19-related complaints increased 1.67 times (117/312 vs. 61/272, p < 0.001). Both prior to and during the COVID-19 pandemic, management-related complaints represented the highest domain. During the COVID-19 pandemic, the implementation of infectious disease prevention and control policies and actions may have developed some inconvenience and difficulty in seeking medical practice and process. These characteristics (complaints) are more prominent, and timely and patient-first consideration is required immediately to build up better clinical procedures, the healthcare environment and comprehensive communication. Using the HCAT can allow health centers or health practitioners to understand the needs and demands of patients through complaints, provide friendly medical and health services, avoid unequal information transmission, build trust in doctor−patient relationships and improve patients' safety.

Association between grip strength and anthropometric characteristics in the community-dwelling elderly population in Taiwan.

BACKGROUND: Sarcopenia and muscle weakness in elderly are contributed burden of public health and impact on quality of life. Weak grip strength was key role in diagnosis of sarcopenia and reported increased mortality, function declined in elderly. This study evaluated the association between GS and each common anthropometric characteristic in community-dwelling elderly. DESIGN AND METHOD: From 2017 to 2019, we conducted a community-based health survey among the elderly in Chiayi county, Taiwan. Participants were 65 years old or older, and total of 3,739 elderly subjects (1,600 males and 2,139 females) with a mean age of 76 years (range 65-85 years old) were recruited. General demographic data and lifestyle patterns were measured using a standard questionnaire. Anthropometric characteristics such as body height, body weight, body mass index (BMI), body waist and hip circumference, and body fat were measured by standard methods. GS was measured using a digital dynamometers (TKK5101) method. RESULTS: The mean GS was 32.8 ± 7.1 kg for males and 21.6 ± 4.8 kg for females (p < 0.001). For both sexes, elderly subjects with the same body weight but smaller body waist circumference had greater GS. The subjects with the same body waist size but heavier weight had greater GS. Furthermore, after adjusting for age, lifestyles, disease status, and potential anthropometric variable, multivariate regression analyses indicated that BMI was positively associated with GS (for males, beta = 0.310 and for females beta = 0.143, both p < 0.001) and body waist was negatively associated with GS (for males, beta = -0.108, p < 0.001; for females, beta = -0.030, p = 0.061). CONCLUSIONS: This study suggested that old adults with higher waist circumstance had weaker GS. Waist circumstance was negatively associated with GS, body weight was positively associated with GS in contrast. It may implies that central obesity was more important than overweight for GS in elderly.

Relationship of Multimorbidity, Obesity Status, and Grip Strength among Older Adults in Taiwan.

Background: The combination of multiple disease statuses, muscle weakness, and sarcopenia among older adults is an important public health concern, and a health burden worldwide. This study evaluates the association between chronic disease statuses, obesity, and grip strength (GS) among older adults in Taiwan. Methods: A community-based survey was conducted every 3 years among older adults over age 65, living in Chiayi County, Taiwan. Demographic data and several diseases statuses, such as diabetes mellitus, hypertension, cerebrovascular disease, cardiovascular disease, and certain cancers, were collected using a questionnaire. Anthropometric characteristics were measured using standard methods. Grip strength was measured using a digital dynamometer (TKK5101) method. Results: A total of 3739 older individuals were recruited (1600 males and 2139 females) with the mean age of 72.9 years. The mean GS was 32.8 ± 7.1 kg for males and 21.6 ± 4.8 kg for females. GS significantly decreased most in males with cerebrovascular disease (from 33.0-29.5 kg, p < 0.001) and in females with diabetes mellitus (from 21.8-21.0 kg, p < 0.01). GS was highest in older adults with obesity (body mass index ≥ 27 kg/m2); however, there was no significant change of GS as the disease number increased. Conclusion: Older adults who have two, rather than one or greater than three chronic diseases, have significantly lower GSs than those who are healthy. Stroke and CKD for males, and hypertension and diabetes for females, are important chronic diseases that are significantly associated with GS. Furthermore, being overweight may be a protective factor for GS in older adults of both sexes.

Adverse childhood experiences and development of obesity and diabetes in adulthood-A mini review.

Obesity has been steadily rising in the last few decades and to some extent, have been linked to exposure of adverse childhood experiences (ACEs). ACEs are intense stressors or traumatic events experienced or witnessed by children, ranging from all types of abuse (physical, emotional, and sexual), neglect, substance abuse or community violence. These traumatic events deprive the sense of safety and stability of a child, leaving psychological and physiological effects that span into adulthood. The prevalence of ACEs is common across developed and developing countries alike, though the rates differ across ethnicities. Using the United States as an example, the prevalence of ACEs experienced by communities of color is higher than white children. Children around the world could all be exposed to ACEs, hence the original questionnaire capturing the score of ACE has been adapted to different cultural situations. The mechanism linking ACEs to obesity during adulthood include biological, psychological, and environmental factors. Nevertheless, a higher ACE score heightens the risk of poor mental health, attempted suicide and development of obesity and diabetes in adulthood. Prevention of ACEs starts from building positive relationships within families, developing healthy relationship skills, and screening of ACEs during early and routine pediatrician's and primary care visits. Intervention needs to include case management services and psychosocial support programs. When these risk factors are intervened early, it lessens the risk of obesity and diabetes in adulthood.

The relationship of irisin with metabolic syndrome components and insulin secretion and resistance in schoolchildren.

ABSTRACT: Irisin, a novel myokine, is believed to be the crucial factor in converting white adipose tissue to beige adipose tissue. For this paper, we studied the relationship among irisin and components of metabolic syndrome (MetS), and insulin secretion and resistance in schoolchildren of Taiwan.Subjects receiving routine annual health examination at elementary school were enrolled. Demographic data, anthropometry, MetS components, irisin, and insulin secretion and resistance were collected. Subjects were divided into normal, overweight, and obese groups for evaluation of irisin in obesity. Finally, the relationship between irisin and MetS was analyzed.There were 376 children (179 boys and 197 girls), aged 10.3 ±â€Š1.5 years, were enrolled. In boys, irisin levels were not associated with body mass index percentile, body fat, blood pressure, lipid profiles, insulin secretion or resistance. After adjusting for age, the irisin level in boys was negatively related to fasting plasma glucose (FPG) (r = -0.21, P = .006). In girls, after adjusting for age, the irisin levels were positively related only to FPG (r = 1.49, P = .038). In both genders, irisin levels were similar among normal, overweight, and obese groups, and between subjects with and without MetS.The irisin levels were not associated with MetS in either boys or girls. In girls, circulating irisin levels have a nonsignificant declining trend in overweight and obese girls. However, irisin levels were negatively related to FPG in boys and positively related to FPG in girls. The contrary relationship between irisin and FPG in boys and girls needs further exploration.

Author Correction: Angiotensin-converting enzyme inhibitors or angiotensin receptor blocker monotherapy retard deterioration of renal function in Taiwanese chronic kidney disease population.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Author Correction: Relationship between body mass index and renal function deterioration among the Taiwanese chronic kidney disease population.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Angiotensin-converting enzyme inhibitors or angiotensin receptor blocker monotherapy retard deterioration of renal function in Taiwanese chronic kidney disease population.

It remains unclear how different uses of angiotensin-converting inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) influence the progression of chronic kidney disease (CKD). This study explored CKD progression in a multicentre, longitudinal cohort study that included 2639 patients with CKD stage 1-5 and hypertension. Patients treated with ACEI or ARB for ≥90 days during a 6-mo period comprised the study group, or no treatment, comprised the control group. The study group was subdivided on the basis of treatment: ACEI monotherapy or ARB monotherapy. Progression of renal deterioration was defined by an average eGFR decline of more than 5 mL/min/1.73 m2/yr or the commencement of dialysis. With at least 1-year follow up, a progression of renal deterioration was demonstrated in 29.70% of the control group and 25.09% of the study group. Patients in the study group had significantly reduced progression of CKD with adjusted odds ratio 0.79 (95% confidence interval: 0.63-0.99). However, when ACEI monotherapy and ARB monotherapy were analyzed separately, none of their associations with CKD progression was statistically significant. In conclusion, ACEI or ARB monotherapy may retard the deterioration of renal function among patients with CKD and hypertension.

Relationship between body mass index and renal function deterioration among the Taiwanese chronic kidney disease population.

This study investigated the characteristics of patients with different chronic kidney disease (CKD) stages according to various body mass index (BMI) categories and determined the influence of BMI in renal function deterioration. We conducted a multicenter, longitudinal cohort study based on the Epidemiology and Risk Factors Surveillance of CKD project (2008-2013) and National Health Insurance Research Database (2001-2013). A total of 7357 patients with CKD aged 20-85 years from 14 hospitals were included in the study. A higher male sex, diabetes mellitus (DM) and hypertension were noted among overweight and obese CKD patients, while more cancer prevalence was noted among underweight CKD patients. Charlson comorbidity index was significantly higher and correlated with BMI among late CKD patients. Patients with BMI < 18.5 kg/m2 exhibited non-significantly higher events of eGFR decline events in both early and late CKD stages than other BMI groups. BMI alone is not a determinant of CKD progression among our Taiwanese CKD patients. Obesity should be re-defined and body weight manipulation should be individualized in CKD patients.

Relationship between plasma adropin levels and body composition and lipid characteristics amongst young adolescents in Taiwan.

Adropin is a 76 amino acid peptide hormone with a molecular weight of 4999.9Da that may be associated with energy homeostasis, insulin resistance and lipid metabolism in mice and human. There is only a few studies that examine plasma adropin levels and body composition in children. This study is to evaluate the relationship between plasma adropin levels, body composition and lipid variables amongst young adolescents in Taiwan. We examined 492 adolescents (269 females and 223 males) ranging from 12 to 15 years old, with a mean age of 13.6 years. Body composition was measured using impedance method by Tanita-BC418. Plasma lipid variables were measured using standard methods and plasma adropin levels were measured using the ELISA method. There was no significant difference in plasma adropin levels between males and females (3.52 vs. 3.58ng/ml). Plasma adropin levels were negatively correlated with fat free mass (r=-0.12, p<0.01). More interestingly, children with higher plasma adropin levels had lower waist-to-hip ratios (WHR) and lower body fat percentage by mass. Furthermore, there is no difference in lipid profiles in high vs. low adropin subjects. Plasma adropin levels are not consistency associated with body composition and no association with lipid variables amongst Taiwanese adolescents. The role of adropin in the development of obesity is still not clear, and further studies are need especially for children.

Prevalence and Trends of Cigarette Smoking Among Military Personnel in Taiwan: Results of 10-Year Anti-Smoking Health Promotion Programs in Military.

OBJECTIVES: The purpose of this study is to evaluate the prevalence and trends of cigarette smoking among young military conscripts, military officers, and military university students during recently 10 years in Taiwan. METHODS: Repeated cross-sectional surveys were conducted annually among young military conscripts and military university students from 2006 to 2014. All the young conscripts were reviewed within 1 month at the military training center and before retiring after 1 year of military services. The military officers were included using purposive sampling from 2004 to 2008 and 2013 to 2014 in different military services. Military university students were included in this study. Freshman and senior students were random sampled as the study subjects. Participants completed a structured questionnaire that included questions on general demographics and health-related behaviors. Current smokers is defined as subjects who smoked ≥1 cigarette/day during the past 30 days or had smoked ≥100 cigarettes in their lifetime or still have the habit of smoking during study. We used a χ2 test to examine the difference between the prevalence of cigarette smoking among different groups. The Cochran-Armitage test for trend was applied to examine the change of prevalence of smoking after repeated cross-sectional surveys among populations. RESULTS: The prevalence of cigarette smoking within military training center and after 1-year military services was 48.6% and 48.1% on 2006, which became 39.2% and 38.6% on 2010, and then further declined to 31.0% and 30.1% on 2014. For military officers, the trends of prevalence of smoking among different military services showed slight decline from 2004 to 2008, but decreased significantly between 2013 and 2014. The prevalence of smoking in 2014 was 32.1%, 32.8%, and 32.4% for the Army, Navy, and Air Force, respectively. More interestingly, the prevalence of smoking of freshman and senior students increased during the first 5 years (2007-2011) of survey and then decreased after 2012. Furthermore, in 2014, the prevalence of smoking decreased as the difference became smaller, 4.5% and 6.1% for freshman and senior, respectively. CONCLUSION: During this 10-year period, the smoking cessation programs include in-class education course, out-door physical training, antismoking clinic, and group therapy. After these military health promoting programs, there are some beneficial effects to decline the prevalence of cigarette smoking for military personnel in Taiwan. However, more active intervention and health promoting programs in prevention and cessation of smoking are needed for the military. The military also have to develop specific approaches and programs to prevent cigarette smoking among conscripts and officers.

Circulating Soluble IL-6 Receptor Concentration and Visceral Adipocyte Size Are Related to Insulin Resistance in Taiwanese Adults with Morbid Obesity.

BACKGROUND: Morbid obesity is related to chronic inflammation and many metabolic complications. Interleukin (IL)-6 plays a pivotal pathophysiological role in obesity, and IL-6 trans-signaling through the soluble IL-6 receptor (sIL-6R) has a major proinflammatory effect. The aim of this study was to investigate the association between sIL-6R, adipocyte size, and insulin resistance in morbidly obese individuals. METHODS: We measured concentrations of sIL-6R, high-sensitivity C-reactive protein, and lipid parameters and estimated homeostasis model assessment of insulin resistance (HOMA-IR) before the patients underwent bariatric surgery. Mesenteric adipose tissue was collected during surgery, and adipocyte size and concentrations of membrane-bound IL-6 receptor (mIL-6R) were evaluated. In total, 35 adults (20 men and 15 women) were recruited. RESULTS: The subjects with high HOMA-IR (≥2.4) had higher fasting glucose/insulin, triglycerides, sIL-6R, and adipocyte size and lower high-density lipoprotein cholesterol and mIL-6R than those with low HOMA-IR (<2.4). Adipocyte size positively correlated with sIL-6R (r = 0.559, P = 0.001) and HOMA-IR (r = 0.773, P ≤ 0.001) independent of age, gender, body mass index (BMI), waist, and use of diabetic drugs. In addition, every 1 ng/mL increase in sIL-6R concentration corresponded to a 10.2% decrease in the likelihood of maintaining lower insulin resistance. Furthermore, an sIL-6R level of 77.45 ng/mL was a reasonable cutoff level to propose lower insulin resistance in morbidly obese subjects. CONCLUSIONS: Circulating sIL-6R is more closely associated with insulin resistance status than waist-to-hip ratio or BMI in morbidly obese Taiwanese adults. sIL-6R may be a useful biomarker to assess insulin resistance among morbidly obese subjects.